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5. Sports Medicine MCQs

Practice Set 284 of 360

This practice set contains high-yield board review questions covering key concepts in 5. Sports Medicine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 5661

Topic: Knee Sports

Radiographs of the spine in a patient with end-stage renal disease reveal alternating radiolucent and radiodense bands parallel to the vertebral endplates. This "Rugger-Jersey" appearance is primarily due to which of the following?

. Accumulation of unmineralized osteoid
. Excessive subperiosteal resorption
. Osteosclerosis secondary to elevated parathyroid hormone
. Microfractures and callus formation
. Deposition of calcium pyrophosphate

Correct Answer & Explanation

. Osteosclerosis secondary to elevated parathyroid hormone

Explanation

The "Rugger-Jersey" spine is characteristic of renal osteodystrophy (secondary hyperparathyroidism). The prominent radiodense bands at the superior and inferior vertebral endplates are a form of osteosclerosis resulting from prolonged high levels of PTH.

Question 5662

Topic: Knee Sports

A 14-year-old girl with Down syndrome presents with recurrent, habitual patellar dislocations. Nonoperative management has failed. Operative intervention in this population is challenging due to generalized ligamentous laxity. Which approach is most often required for successful stabilization?

. Isolated lateral retinacular release
. Isolated medial patellofemoral ligament (MPFL) reconstruction
. Combined bony realignment and soft-tissue stabilization
. Arthroscopic thermal capsulorrhaphy
. Patellectomy

Correct Answer & Explanation

. Combined bony realignment and soft-tissue stabilization

Explanation

Patellofemoral instability in Down syndrome is multifactorial, involving generalized laxity, hypoplastic trochleas, and valgus alignment. Isolated soft tissue procedures have a high failure rate, usually necessitating combined bony (e.g., tibial tubercle transfer, distal femoral osteotomy) and soft-tissue reconstruction.

Question 5663

Topic: Knee Sports

A 16-year-old male with a history of systemic JIA is currently treated with Etanercept. He sustained an anterior cruciate ligament tear and is scheduled for reconstruction. What is the recommended perioperative management of his biologic medication?

. Continue Etanercept without interruption
. Stop Etanercept 1 week before surgery and resume 1 week after
. Withhold Etanercept for at least one to two dosing cycles prior to surgery
. Switch Etanercept to oral methotrexate perioperatively
. Double the dose of Etanercept to prevent a post-operative flare

Correct Answer & Explanation

. Withhold Etanercept for at least one to two dosing cycles prior to surgery

Explanation

Etanercept is a TNF-alpha inhibitor. To minimize the risk of postoperative infection, current guidelines recommend withholding biologic agents for one to two dosing intervals before an elective orthopedic surgery, resuming once wound healing is satisfactory.

Question 5664

Topic: 5. Sports Medicine

A 4-year-old boy presents with a painless mass on the medial aspect of his ankle. Radiographs show an irregular, ossified mass arising from the talar epiphysis.

For an asymptomatic patient with this confirmed condition, what is the most appropriate initial management?

. Immediate en bloc resection with allograft reconstruction
. Observation with serial clinical and radiographic examinations
. Radiotherapy to halt cartilaginous growth
. Below-knee amputation
. Intralesional injection of corticosteroids

Correct Answer & Explanation

. Observation with serial clinical and radiographic examinations

Explanation

In the absence of pain, mechanical impingement, or joint deformity, DEH can be managed conservatively with serial observation. Surgical excision is reserved for symptomatic or deforming lesions.

Question 5665

Topic: Knee Sports

What is the primary pathophysiologic mechanism by which DEH causes joint pain and restricted range of motion?

. Systemic inflammatory auto-immune response
. Infiltration of surrounding neurovascular bundles
. Intra-articular space occupation causing mechanical block and joint incongruity
. Frequent microfractures of the subchondral bone
. Rapid expansion due to malignant cell proliferation

Correct Answer & Explanation

. Intra-articular space occupation causing mechanical block and joint incongruity

Explanation

DEH produces an asymmetric, space-occupying cartilaginous mass within the joint. This leads directly to mechanical locking, joint incongruity, and resultant pain during motion.

Question 5666

Topic: Knee Sports

During a medial opening-wedge high tibial osteotomy (HTO), the surgeon aims to correct a varus deformity. If the osteotomy gap is opened disproportionately wider anteriorly than posteriorly, what is the most significant biomechanical consequence?

. Decreased posterior tibial slope
. Increased posterior tibial slope
. Coronal translation of the distal fragment
. Increased patellar height
. Patellofemoral instability

Correct Answer & Explanation

. Increased posterior tibial slope

Explanation

The normal proximal tibia has an inherent posterior slope. Opening the osteotomy wider anteriorly than posteriorly will increase the posterior tibial slope, which alters knee kinematics and places increased tension on the anterior cruciate ligament.

Question 5667

Topic: Knee Sports

A 9-year-old boy with poorly controlled JIA presents with a progressive unilateral knee deformity. The affected knee exhibits overgrowth and a fixed flexion contracture. Which phenomenon best explains the observed limb length discrepancy?

. Premature physeal closure from systemic corticosteroids
. Increased blood flow to the physes secondary to chronic synovitis
. Asymmetric muscular pull from hamstring spasticity
. Direct cartilage destruction by matrix metalloproteinases
. Disuse osteopenia leading to microfractures and bone lengthening

Correct Answer & Explanation

. Increased blood flow to the physes secondary to chronic synovitis

Explanation

Chronic synovitis in JIA causes intense local hyperemia. This increased regional blood supply stimulates the adjacent open physes, resulting in premature bone overgrowth and a limb length discrepancy.

Question 5668

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player is undergoing an open Latarjet procedure for recurrent anterior shoulder instability associated with 25% glenoid bone loss. During the procedure, the coracoid process is osteotomized and transferred to the anterior glenoid. To create the dynamic "sling effect" that contributes to the stability provided by this procedure, the coracoid and its attached conjoint tendon are passed through a split in which of the following structures?

. Pectoralis major tendon
. Pectoralis minor tendon
. Subscapularis muscle
. Anterior capsule
. Coracoacromial ligament

Correct Answer & Explanation

. Subscapularis muscle

Explanation

Correct Answer: CThe Latarjet procedure provides stability through a "triple effect": 1) the bony augmentation of the anterior glenoid defect, 2) the dynamic "sling effect" of the conjoint tendon (short head of biceps and coracobrachialis), and 3) the repair of the capsule to the stump of the coracoacromial ligament. To achieve the sling effect, the coracoid and conjoint tendon are passed through a horizontal split made in the subscapularis muscle (typically between its superior two-thirds and inferior one-third). When the arm is abducted and externally rotated (the position of vulnerability), the conjoint tendon acts as a dynamic sling across the anterior-inferior capsule, preventing anterior translation of the humeral head.

Question 5669

Topic: Shoulder & Hip Sports

A 26-year-old professional volleyball player presents with painless weakness in his dominant right shoulder. Physical examination reveals normal 5/5 strength in supraspinatus testing (empty can test), but isolated 3/5 strength in external rotation with the arm at the side. There is visible atrophy of the infraspinatus fossa. Where is the most likely anatomical site of nerve compression?

. Suprascapular notch.
. Spinoglenoid notch.
. Quadrilateral space.
. Triangular interval.
. Spiral groove.

Correct Answer & Explanation

. Spinoglenoid notch.

Explanation

Correct Answer: BThe patient presents with isolated weakness and atrophy of the infraspinatus muscle, which is innervated by the suprascapular nerve. The suprascapular nerve passes through the suprascapular notch (where it innervates the supraspinatus) and then courses around the base of the scapular spine through the spinoglenoid notch to innervate the infraspinatus. Compression at the suprascapular notch (e.g., by the transverse scapular ligament) typically causes weakness in BOTH the supraspinatus and infraspinatus. Compression at the spinoglenoid notch (often due to a paralabral cyst associated with a posterior labral tear in overhead athletes) results in isolated infraspinatus weakness, as the motor branches to the supraspinatus have already branched off proximally. The quadrilateral space contains the axillary nerve.

Question 5670

Topic: 5. Sports Medicine

A 14-year-old female gymnast presents with chronic lateral elbow pain and mechanical catching. Radiographs reveal a radiolucent defect in the capitellum with a suspected intra-articular loose body, consistent with osteochondritis dissecans (OCD). This pathology is primarily driven by which of the following biomechanical forces during weight-bearing upper extremity activities?

. Medial tension.
. Lateral compression (valgus overload).
. Posterior shear.
. Anterior translation.
. Varus overload.

Correct Answer & Explanation

. Lateral compression (valgus overload).

Explanation

Correct Answer: BOsteochondritis dissecans (OCD) of the capitellum is typically seen in adolescent athletes involved in repetitive overhead or upper-extremity weight-bearing sports, such as gymnastics and baseball pitching. The primary biomechanical driver is repetitive valgus stress across the elbow joint. This valgus stress creates tension on the medial structures (e.g., MUCL) but simultaneously causes severe lateral compression forces across the radiocapitellar joint. This repetitive, excessive compressive loading leads to focal ischemia, microfracture, and eventual avascular necrosis of the vulnerable subchondral bone of the capitellum, resulting in OCD and potential loose body formation.

Question 5671

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player with recurrent anterior shoulder instability and 25% anterior glenoid bone loss undergoes an open Latarjet procedure. During the transfer of the coracoid process through the split in the subscapularis muscle, retractors are placed medially under the conjoint tendon. Which of the following nerves is at greatest risk of iatrogenic injury during this specific step of the procedure?

. Axillary nerve
. Suprascapular nerve
. Musculocutaneous nerve
. Radial nerve
. Long thoracic nerve

Correct Answer & Explanation

. Musculocutaneous nerve

Explanation

Correct Answer: CDuring the Latarjet procedure, the coracoid process (with the attached conjoint tendon—short head of the biceps and coracobrachialis) is transferred to the anterior glenoid. The musculocutaneous nerve typically enters the coracobrachialis muscle approximately 3 to 8 cm distal to the tip of the coracoid process. When retracting the conjoint tendon medially to expose the anterior glenoid and subscapularis, aggressive or deep retractor placement can stretch or directly compress the musculocutaneous nerve. The axillary nerve (Option A) is at risk inferiorly during capsular release and glenoid preparation. The suprascapular nerve (Option B) is posterior and superior, not typically at risk during the anterior coracoid transfer. The radial nerve (Option D) is posterior to the humerus. The long thoracic nerve (Option E) is medial on the chest wall.

Question 5672

Topic: Shoulder & Hip Sports

During an arthroscopic rotator cuff repair, the surgeon aims to restore the native tendon-to-bone insertion (enthesis) to optimize healing. In a normal, healthy direct tendon insertion, the transition from tendon to bone occurs through four distinct histological zones. Which zone lies immediately superficial to the "tidemark"?

. Mineralized bone
. Calcified fibrocartilage
. Uncalcified fibrocartilage
. Parallel collagen fibers of the tendon
. Loose areolar connective tissue

Correct Answer & Explanation

. Uncalcified fibrocartilage

Explanation

Correct Answer: CA direct tendon insertion (enthesis), such as the rotator cuff footprint, consists of four distinct histological zones that transition mechanical stress from the compliant tendon to the rigid bone. From superficial to deep, these zones are: 1) Tendon (parallel collagen fibers), 2) Uncalcified fibrocartilage, 3) Calcified fibrocartilage, and 4) Bone. The "tidemark" is a distinct basophilic line that separates the uncalcified fibrocartilage from the calcified fibrocartilage. Therefore, the zone immediately superficial to the tidemark is the uncalcified fibrocartilage. Understanding this anatomy is crucial because surgical repair often results in healing via a fibrovascular scar rather than regeneration of this complex 4-zone enthesis, which contributes to the risk of re-tear.

Question 5673

Topic: Shoulder & Hip Sports

A 22-year-old rugby player undergoes an open Latarjet procedure for recurrent anterior shoulder instability with 25% glenoid bone loss. The success of this procedure relies on a "triple blocking" effect. Which of the following muscles constitutes the dynamic "sling effect" across the anterior-inferior capsule when the arm is in the abducted and externally rotated position?

. Short head of the biceps and coracobrachialis
. Long head of the biceps and pectoralis minor
. Subscapularis and pectoralis major
. Coracobrachialis and pectoralis minor
. Short head of the biceps and subscapularis

Correct Answer & Explanation

. Short head of the biceps and coracobrachialis

Explanation

Correct Answer: A (Short head of the biceps and coracobrachialis)The Latarjet procedure involves transferring the coracoid process, along with its attached conjoint tendon, to the anterior-inferior glenoid neck. The "triple blocking" effect consists of: 1) a bony block from the transferred coracoid, 2) a dynamic "sling effect" from the conjoint tendon, and 3) capsular repair (often using the coracoacromial ligament stump). The conjoint tendon is composed of the short head of the biceps brachii and the coracobrachialis. When the arm is placed in the vulnerable position of abduction and external rotation, these muscles contract and act as a dynamic sling across the anterior-inferior capsule, preventing anterior translation of the humeral head. The pectoralis minor inserts on the medial aspect of the coracoid and is typically released during the procedure. The long head of the biceps originates from the supraglenoid tubercle.

Question 5674

Topic: Shoulder & Hip Sports

A 26-year-old professional volleyball player presents with insidious onset of posterior shoulder pain and weakness in his dominant arm. Physical examination reveals normal strength in forward elevation and abduction, but 3/5 strength in external rotation with the arm at the side. There is noticeable atrophy of the infraspinatus fossa, but the supraspinatus fossa appears normal. At which of the following anatomic locations is the affected nerve most likely compressed?

. Suprascapular notch.
. Spinoglenoid notch.
. Quadrilateral space.
. Spiral groove.
. Cubital tunnel.

Correct Answer & Explanation

. Spinoglenoid notch.

Explanation

Correct Answer: Spinoglenoid notch.The patient presents with isolated weakness and atrophy of the infraspinatus muscle, indicating an entrapment of the suprascapular nerve at the spinoglenoid notch. The suprascapular nerve branches off the upper trunk of the brachial plexus, passes through the suprascapular notch (under the transverse scapular ligament) where it innervates the supraspinatus muscle. It then courses around the base of the scapular spine through the spinoglenoid notch to innervate the infraspinatus. Compression at the suprascapular notch would result in weakness ofboththe supraspinatus (abduction) and infraspinatus (external rotation). Compression at the spinoglenoid notch, often seen in overhead athletes due to repetitive stretching or paralabral cysts, results in isolated infraspinatus weakness. The quadrilateral space contains the axillary nerve; the spiral groove contains the radial nerve; the cubital tunnel contains the ulnar nerve.

Question 5675

Topic: Shoulder & Hip Sports

A 21-year-old collegiate baseball pitcher presents with chronic posterior shoulder pain. An MRI arthrogram reveals a partial articular-sided supraspinatus tendon avulsion (PASTA lesion) and posterosuperior labral fraying. The treating physician diagnoses internal impingement. This specific pathology is most likely exacerbated by the impingement of the rotator cuff and labrum against the posterosuperior glenoid rim during which phase of the throwing motion?

. Wind-up.
. Early cocking.
. Late cocking / maximal external rotation.
. Acceleration.
. Follow-through.

Correct Answer & Explanation

. Late cocking / maximal external rotation.

Explanation

Correct Answer: Late cocking / maximal external rotation.Internal impingement (posterosuperior impingement) is a pathological condition commonly seen in overhead athletes, particularly baseball pitchers. It occurs when the arm is placed in extreme abduction and maximal external rotation—the classic position of the 'late cocking' phase of throwing. In this position, the articular surface of the posterior rotator cuff (supraspinatus and infraspinatus) becomes pinched between the greater tuberosity of the humerus and the posterosuperior glenoid rim and labrum. Over time, this repetitive microtrauma leads to articular-sided rotator cuff tears (like PASTA lesions) and posterosuperior labral fraying or tears. The acceleration phase involves rapid internal rotation, and the follow-through phase involves deceleration and cross-body adduction, neither of which produces this specific posterosuperior pinch.

Question 5676

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player presents with recurrent anterior shoulder instability. CT scan with 3D reconstruction reveals an inverted pear-shaped glenoid with 28% anterior glenoid bone loss. He undergoes a Latarjet procedure. Biomechanically, what is the primary mechanism by which this procedure confers stability in abduction and external rotation?

. Restoration of the anterior glenoid articular arc length
. Sling effect of the conjoint tendon on the inferior subscapularis and capsule
. Re-tensioning of the coracoacromial ligament
. Dynamic tensioning of the pectoralis minor
. Prevention of Hill-Sachs engagement via cam effect

Correct Answer & Explanation

. Sling effect of the conjoint tendon on the inferior subscapularis and capsule

Explanation

The Latarjet procedure provides stability through three main mechanisms. The most significant stabilizing factor in the abducted and externally rotated position is the 'sling effect' of the conjoint tendon compressing the inferior subscapularis and anterior capsule.

Question 5677

Topic: Shoulder & Hip Sports

A 22-year-old collegiate rugby player presents with recurrent anterior shoulder instability. Advanced imaging demonstrates an engaging Hill-Sachs lesion and 25% anterior glenoid bone loss. Which of the following surgical interventions is most appropriate to restore stability and prevent recurrence?

. Arthroscopic Bankart repair with remplissage
. Open Bankart repair with inferior capsular shift
. Coracoid transfer to the anterior glenoid (Latarjet procedure)
. Arthroscopic capsular plication
. Proximal humerus derotational osteotomy

Correct Answer & Explanation

. Coracoid transfer to the anterior glenoid (Latarjet procedure)

Explanation

In the setting of significant anterior glenoid bone loss (>20-25%), soft tissue stabilization alone has unacceptably high failure rates. The Latarjet procedure provides a triple blocking effect (bone, sling, and capsule) to definitively restore stability in these high-risk patients.

Question 5678

Topic: 5. Sports Medicine

A 32-year-old male is evaluated for a locked posterior shoulder dislocation sustained during a seizure. CT imaging reveals an anteromedial humeral head impaction fracture (reverse Hill-Sachs lesion) involving 30% of the articular surface. Which of the following is the most appropriate surgical management?

. Closed reduction and sling immobilization in internal rotation
. Arthroscopic posterior labral repair
. Transfer of the lesser tuberosity into the defect (McLaughlin procedure)
. Osteochondral allograft reconstruction of the humeral head
. Anatomic total shoulder arthroplasty

Correct Answer & Explanation

. Transfer of the lesser tuberosity into the defect (McLaughlin procedure)

Explanation

For reverse Hill-Sachs lesions involving 20-40% of the articular surface, transferring the lesser tuberosity with the attached subscapularis tendon into the defect (modified McLaughlin procedure) effectively prevents engagement and restores stability. Arthroplasty is reserved for older patients or defects >40%.

Question 5679

Topic: Shoulder & Hip Sports

A 22-year-old male rugby player presents with recurrent anterior shoulder instability. CT scan shows 25% anterior glenoid bone loss. He undergoes a Latarjet procedure. Which of the following describes the primary stabilizing biomechanical "sling" effect of this procedure?

. Conjoined tendon tensioning across the inferior subscapularis
. Coracoacromial ligament transfer to the anterior capsule
. Bony block increasing the glenoid articular arc
. Dynamic tensioning of the long head of the biceps
. Static tensioning of the middle glenohumeral ligament

Correct Answer & Explanation

. Conjoined tendon tensioning across the inferior subscapularis

Explanation

The Latarjet procedure provides stability primarily through the dynamic sling effect of the conjoined tendon on the lower subscapularis and anteroinferior capsule. This effect is most pronounced when the arm is in the vulnerable abducted and externally rotated position. The bony block and capsular repair play secondary stabilizing roles.

Question 5680

Topic: Shoulder & Hip Sports

A 28-year-old elite volleyball player presents with insidious onset of posterior shoulder pain and isolated weakness in external rotation. An MRI reveals a paralabral cyst at the spinoglenoid notch. Which of the following associated intra-articular pathologies is most likely responsible for this cyst?

. Anterior Bankart tear
. SLAP tear extending anteriorly
. Posterior labral tear
. Superior capsular defect
. Subscapularis tendon tear

Correct Answer & Explanation

. Posterior labral tear

Explanation

Paralabral cysts at the spinoglenoid notch typically arise from a one-way valve effect caused by a posterior or posterosuperior labral tear. These cysts selectively compress the suprascapular nerve after it has already innervated the supraspinatus, leading to isolated infraspinatus atrophy and external rotation weakness.

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